Is it possible that you are lean and still suffer from PCOS?
When your doctor diagnoses you with PCOS it may be hard to believe.
‘I have a normal BMI and I am lean. Still, how can I suffer from PCOS?’This question can pop up in your mind.
But PCOS is not always a disease of obese women. Although a majority of women diagnosed with PCOS are obese a small proportion of women diagnosed with PCOS are lean with normal BMI.
Do Lean PCOS women have the same features as classic PCOS?
The clinical manifestations in lean PCOS women are comparable with obese PCOS women. The majority of lean PCOS women are diagnosed with insulin resistance. They also present with clinical features like acanthosis nigricans, hirsutism, irregular menstrual cycle, and infertility. Hormonal profiles of LH, FSH, and testosterone also are similar in both the phenotypes of PCOS.
Visceral fat and Lean PCOS:
A lean patient may have a normal BMI but may be classified as obese when the patient stands on a weighing scale measuring visceral fat.
What is visceral fat?
Visceral fat is the intra abdominal fat and is found around different vital organs like the liver, intestine, and pancreas. The estimation of visceral fat may be helpful in analyzing the risk for various conditions like Diabetes mellitus, cancer, and cardiovascular diseases.
How to Measure Visceral fat?
A rough estimate of the visceral fat in the body may be done by analyzing waist to hip ratio. Take the measurements of the largest parts around your waist and hip and divide the measurement of the waist by that of the hip. A waist to hip ratio of more than 0.85 for females may be an indicator of excess visceral fat.
Visceral fat is measured accurately by the method of Bioelectrical impedance analysis. Several body composition monitors are available which can measure the visceral fat accurately.
Body composition analyzers measure visceral fat on a scale of 1 to 59. A rating of 1 to 12 is considered healthy and a value between 13 to 59 indicates excess visceral fat.
It is important to track visceral fat in lean PCOS patients as this is the unseen fat that is responsible for the complications.
Management of Lean PCOS:
Like the other phenotypes of PCOS, lean PCOS is also initially managed by lifestyle modification with a regular diet and exercise. The patient is encouraged to add lots of fruits and vegetables to the diet. Adding calcium, vitamin D, and zinc to the diet has proved to be beneficial. If the condition is not controlled with diet and exercise, then pharmacotherapy with drugs like Metformin is advised. Myoinositol has shown beneficial effects in some cases.
Other clinical features like hirsutism, menstrual irregularities, and acne may be treated with antiandrogens and oral contraceptives.
Meal Planning for Lean PCOS
Meal planning for a lean PCOS patient can be very difficult. You need not restrict calories like a classic PCOS patient. You have to approach the diet planning in a more rational way.
The glycemic index or GI is measuring how much a carbohydrate-containing food increases your blood sugar and insulin levels. Choosing lower GI foods is important to manage lean PCOS as it helps to manage insulin resistance. Include lots of vegetables in your diet. Avoid food with a high glycemic index like white bread, white rice, and cornflakes.
Include food rich in omega 3 fatty acids like walnuts, flax seeds, and salmon. Replace coffee and tea with green tea, or spearmint tea. Avoid baked food like cakes, cookies, and packaged food.
Plating your meals
Consider a circular plate. 50% of your plate should be filled with vegetables. Fill a quarter plate with protein-rich food like eggs, fish, meat or pulses and the other quarter with carbohydrate-rich food like brown rice, whole grains or oats.
Physical activity like exercise or yoga should be done daily for at least 30 minutes. It is advised to include strength-based exercise and yoga as a part of the daily routine.
Apart from diet and exercise, you should also follow a stress-free lifestyle. A healthy sleep pattern with 8 hours of sleep is essential.
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